Healthcare Provider Details

I. General information

NPI: 1386876746
Provider Name (Legal Business Name): NATHAN JUDD M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 YOUTH TOWN RD
PINSON TN
38366-9804
US

IV. Provider business mailing address

PO BOX 1385
JACKSON TN
38302-1385
US

V. Phone/Fax

Practice location:
  • Phone: 731-988-5251
  • Fax: 731-427-5605
Mailing address:
  • Phone: 731-988-5251
  • Fax: 731-427-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2832
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: